Background/Purpose: Rheumatoid arthritis (RA) patients have been previously shown to have a higher cardiovascular (CV) burden as compared to the general population. The CV risk in RA seems still underestimated. We present here the results of a 1.5 year experience of our Department with the CV risk management in RA patients. 

Methods: RA patients have been consecutively screened on lipid profile and blood pressure. Other CV risk factors have been also recorded (smoking, CV history, family history of premature atherosclerotic events, weight –BMI, renal function, glucose). Patients fulfilled either the 1987 ACR criteria or the revised ACR-EULAR criteria for the diagnosis of RA. They were visiting the outpatient clinic for their regular controls. The SCORE index has been used to determine their 10-year risk to develop CV event/ death by CV event.  

Results: In total, 342 RA patients have been consecutively screened. Among them 181 patients have been tested in primary prevention setting and were further analyzed (Table 1). Forty patients (22%) had hypertension. Thirty-three patients (18%) should have been treated with statins according to their 10-years CV risk as calculated using the algorithms for the general population. This percentage almost tripled (52%) if CBO recommendations for RA patients have been applied. Finally, 17% of the studied group had a high CV risk according to SCORE index for the general population, increasing to 21% according to SCORE-EULAR and to 49% when CBO guidelines recommendations for RA patients have been applied (Table 2). 

Conclusion: There is a relative high percentage of RA patients in need for primary prevention measures, yet the use of SCORE-CBO might easily overestimate/exaggerate the risk. Screening for CV risk factors early in the course of disease should be integrated in the standards protocols for RA management. Applying the “treat to target” strategy together with primary prevention measures might drastically reduce CV burden in RA in the near future. 

Table 1. Main characteristics of the RA group in which the screening has been applied in the primary prevention setting (mean ± SD); BMI = body mass index; HDL = high-density lipoprotein; TC = total cholesterol; 

Table 2. Distribution of CV risk among the 181 RA patients. SCORE-EULAR = SCORE index according to EULAR recommendations (x 1.5 when two of the following factors have been present: rheumatoid factor, disease duration> 10 years, extra-articular manifestations); EULAR-CBO = SCORE according to 2011 CBO guidelines ( adding 15 years to current age)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-management-in-rheumatoid-arthritis-patients/